Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01709 | Date 22/02/2019 |
| Token No | SM/18-19/2566 22/02/2019 | Serial | 009 |
| Patient Name | Miss ROSHMITA SAMAL | Contact No | 9339830034 |
| Address | 21 CHOWDHURI PARA LANE | Age | 20 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||